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BACKGROUND: Anomalous origin of coronary arteries is a rare finding in the general population. Although occasionally asymptomatic with no clinical significance, it can present with chest pain, palpitations, myocardial ischemia, arrhythmia, and sudden cardiac death (SCD). The severity of anomalies is determined by the adequacy of the blood supply to the myocardium and oxygen demand. It was noted that right coronary artery (RCA) anomaly incidence is even lower compared to other coronary artery anomalies. The actual pathophysiology of this entity has varieties however should be put into consideration when evaluating patients with cardiac symptoms. Diagnosis is usually incidental and treatment is controversial.
CASE REPORT: A 53-year-old man with no significant past medical history was admitted to the hospital due to an abnormal computed tomography scan (CT) to evaluate persistent dyspnea after pneumonia treatment 3 weeks prior to the admission. He also had intermitted left-sided chest pain that was resistant to conservative treatment. The CT scan was indicative of RCA origin from the pulmonary artery. The patient subsequently underwent heart catheterization with unremarkable results and cardiology consult did not recommend further intervention. He was discharged home to follow up with his primary care physician.
CONCLUSIONS: Coronary arteries anomalies (CAAs), especially RCA, are considered rare, but can present with fatal outcome. Most patients are asymptomatic during their life span, which makes the diagnosis difficult. The anomaly is usually discovered incidentally, but requires further evaluation it to prevent complications such as SCD.

Keywords: Coronary Vessel Anomalies, Coronary Vessels, Ischemia, Pulmonary Artery